CPT code 99392: Well-child visit, established, age 1–42026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99392 covers

This code is used for a periodic preventive evaluation of an established child age 1 through 4. The visit generally includes an age-appropriate history and examination, review of growth and development, preventive counseling, and anticipatory guidance. Pediatricians, family physicians, and other clinicians provide these visits in office and outpatient practice, often as routine well-child care. Both the child's age and patient status matter when selecting the preventive visit code.

For Medicare, this code has physician fee schedule status N, meaning Medicare does not cover the service. It identifies a preventive visit, not a drug, supply, or timed service, so it is reported as a visit rather than in units based on dose or duration. Use the corresponding age-specific preventive code for a new patient, and select a different established-patient code when the child falls outside the 1–4 age range.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99392 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99392 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99392 rate is calculated

Each of 99392’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99392

99392 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99392 compared with similar codes

How to choose

99382Preventive visitNew patient, age 1-4

99382 is for a new patient age 1–4; 99392 is for an established patient in that age range.

99391Infant preventive visitEstablished patient

99391 applies to established patients under age 1; 99392 applies to established patients age 1–4.

99393Child preventive visitEstablished patient, age 5-11

99393 applies to established patients age 5–11; 99392 applies to established patients age 1–4.

99213Office visitEstablished patient, low complexity

99213 describes an established-patient office or outpatient evaluation for a problem; 99392 describes a periodic preventive visit.

Codes related to 99392

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates